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Diagnostic Accuracy and Prognostic Value of 18F-FDG PET in Hürthle Cell Thyroid Cancer Patients

Daniel A. Pryma1,2, Heiko Schöder1, Mithat Gönen3, Richard J. Robbins4, Steven M. Larson1 and Henry W.D. Yeung1

1 Nuclear Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York; 2 Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; 3 Epidemiology and Biostatistics Department, Memorial Sloan-Kettering Cancer Center, New York, New York; and 4 Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New York


Figure 1
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  		FIGURE 1.  False-positive PET and CT. (A) Increased 18F-FDG uptake is seen in left supraclavicular lymph node (black arrow) on 18F-FDG PET. (B) Lymph node was also interpreted as malignant on dedicated CT (white arrow). Excisional biopsy showed granuloma and Mycoplasma avium grew in culture.

 

Figure 2
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  		FIGURE 2.  (A) Negative 18F-FDG PET before receiving 11.1 GBq (300 mCi) Na131I. Concurrent CT of neck and chest (not shown) was also negative. Anterior (B) and posterior (C) images from posttherapy scan 1 wk after radioiodine therapy show iodine-avid disease in neck and chest. Increased activity along the scalp was confirmed to be surface contamination. After 2 annual doses of 11.1 GBq Na131I, patient has no evidence of disease.

 

Figure 3
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  		FIGURE 3.  Patient with widely metastatic Hürthle cell thyroid cancer. 18F-FDG PET (A) and CT (B) both revealed pulmonary metastases, whereas left rib metastases seen on 18F-FDG PET (C) appear unremarkable on CT (D).

 

Figure 4
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  		FIGURE 4.  Contrast-enhanced diagnostic CT of the neck (A) shows a left level II cervical lymph node interpreted as consistent with metastatic disease (white arrow). (B) 18F-FDG PET shows no uptake in this node. Long-term follow-up demonstrated no evidence of disease.

 

Figure 5
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  		FIGURE 5.  Kaplan–Meier survival curve. Dashed line: Patients with SUVmax ≥ 10 have 5-y all-cause mortality of 64%. Solid line: Patients with SUVmax < 10 have 5-y all-cause mortality of 92% (P < 0.01).

 




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